Building Strong Bones

by Margaret Rosenzweig, PhD, FNP-BC, AOCNP, and Adam Brufsky, MD, PhD

Maintaining bone health is
a vital component of wellness.
A “thinning” of the
bones, known as osteopenia or osteoporosis
(bone marrow density that is
lower than normal), occurs naturally
with age. There are additional factors
that can place you at risk for osteoporosis.
Some risk factors, such as smoking,
a diet lacking in Vitamin D and calcium,
lack of weight bearing exercise,
and chronic persistent stress, can be
controlled, thereby decreasing your risk
of osteoporosis. Other risk factors are
non-modifiable. These include age,
race, gender, small body frame, and
family history.

The skeleton is often at risk during
and after cancer treatment. This is particularly
true in women with a history
of breast cancer who are receiving the
class of drugs known as aromatase inhibitors
or in women with menopause
induced by chemotherapy. The other
category of individuals at risk for osteopenia
or osteoporosis is men with
a history of prostate cancer who are
receiving therapy.

Calcium is necessary to keep bones strong and healthy.
Some drugs used to treat cancer may deplete
the calcium in your body.

It is important to be mindful of bone
health throughout cancer treatment and
beyond. There are many things you can
do to maintain your bone health, including
meeting your daily requirement of
calcium and vitamin D intake, doing
weight bearing exercise, maintaining
a healthy weight, getting appropriate
screening to assess bone mass, and if
necessary, taking prescriptions to build
bone density.

Calcium and Vitamin D Calcium
is an important mineral stored by your
bones and is necessary to keep bones
strong and healthy. Some drugs used to
treat cancer may
deplete the calcium
in your
body. As a result,
you should
be mindful of
your diet and try
to include foods
high in calcium
(green, leafy
vegetables;
cheese; yogurt;
orange juice; pasta; milk). Additionally,
it is important to include enough vitamin
D in your diet because vitamin D
is essential in helping the body absorb
and retain calcium. Vitamin D is manufactured
in the skin, using energy from
sunlight, but it is also found in vitamin D
fortified food. Calcium and vitamin D
supplements may be beneficial for osteoporosis
prevention, but be sure to talk
to your healthcare provider before beginning
a supplement regimen.

Dr. Adam Brufsky

Exercise Exercise, combined with a
balanced diet, is important to bone health.
Physical activity (walking, dancing,
stair climbing, jumping rope) places
stress on your bones and stimulates
the production of cells that cause bone
formation. Regular weight-bearing
exercise also
promotes strong
muscles, which
improves stability
when
standing or
walking and
may reduce incidence
of falls
and osteoporotic
fractures. Be
sure to talk to
your doctor about developing an exercise
program that is appropriate for you.

Screening Cancer and cancer
therapy can change bone metabolism.
Individuals with a history of cancer are
more at risk for osteoporosis and should
receive a routine and regular assessment
of bone health. While a physical examination
can suggest osteoporosis,
screening primarily consists of measuring
bone mineral density. The Dual
Energy X-ray Absorptiometry (DEXA)
scan is considered the gold standard
for measuring bone density, but it is
not performed more than once a year.
Routine cancer imaging studies such
as radiographs, MRI, CT, and PET-CT
may also suggest osteoporosis. Your
healthcare team will help you determine
your risk and the frequency of scans.

Prescriptions Your doctor can track
your bone mass and bone loss on your
bone density scans. If you have been
taking supplements and your bone
density scans still show significant osteoporosis,
your doctor may recommend
bisphosphonates. Bisphosphonate treatment
is used to slow the rate of bone
thinning. It also may reduce new bone
damage and may promote bone healing.
Bisphosphonate therapy is associated
with reduction in the number of hip and
vertebral fractures in women with breast
cancer and has been shown to prevent
bone loss in men with prostate cancer.

Self Care When bones become
weak and fragile, they are more likely
to break and cause pain and disability.
However, there are many things you
can do, or may already be doing, that
can improve your bone health. Exercise
and nutrition are essential to preserving
bone health. Making simple lifestyle
changes will help you build strong
bones – during and after cancer treatment.

♦ ♦ ♦ ♦ ♦

Dr. Margaret Rosenzweig is
assistant professor of Acute and Tertiary
Care and the director of the Oncology Nurse
Practitioner Sub-Speciality at the University
of Pittsburgh School of Nursing.

Dr. Adam
Brufsky is associate professor and associate
chief of Hematology-Oncology at the University
of Pittsburgh School of Medicine,
the interim co-director of the Magee Breast
Cancer Program of UPMC Cancer Centers,
and medical director of the Women’s Cancer
Center at Magee-Womens Hospital of
UPMC in Pittsburgh, PA.

This article was printed from copingmag.com and was originally published in Coping® with Cancer magazine,
May/June
2009.